introduction to the routines-based interview method

Introduction to the Routines-Based Interview MethodKellie Horn khorn@esd123.orgChris Miller chris.miller@esd112.org

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We agree that…__________, with the necessary supports and resources, can enhance their children’s learning and development.

A. Early intervention service providers

B. A few families

C. All families

D. None of the above-It is not possible to provide enough support and resources for families to enhance their children’s learning and development.

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Agenda

•RBI in Real Life

•The purposes of the RBI

•Completing an RBI

•RBI in the IFSP Process

•Implementing the RBI

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The RBI in Real Time

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Observing the Demonstration

•Look for:

▫Good, juicy questions▫Missed Questions▫Nonverbal Behaviors▫Important Assessment Information▫Likely Outcomes

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“Routines are naturally occurring activities happening with some regularity. “ (R.A. McWilliam, 2009)

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3 Main Purposes of the RBI

1. Develop a list of functional IFSP outcomes

2. Assess child and family functioning

3. Establish a positive relationship with the family

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6 Steps for Completing an Interview

•Step #1: Introductions and main concerns

▫Explain the purpose and process

▫Clarify who lives in the home and other resources that may be relevant throughout the interview ecomap

▫*Ask about main concerns for the child and family

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6 Steps for Completing an Interview

• Step #2: Gather information from the family using the family’s routines as the agenda, take notes & star concerns

Six Items:1. What everyone does at this time• Provides information about the task demands of the routine for

everyone 2. What the child does• Assesses the interaction of the child’s interests or abilities with

the demands of the routine3. What the child’s engagement is like

The extent to which and quality with which the child participates in the routine

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6 Steps for Completing an Interview

• Step #2: Gather information from the family using the family’s routines as the agenda, take notes & star concerns (continued)

Six Items (cont.):

4. What the child’s independence is like Extent to which the child can perform the demands of the

routine by himself or herself

5. What the child’s social relationships are like Information about how the child communicates and gets along

with others

6. How satisfied the family is with this routine

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6 Steps for Completing an Interview

•Step #3: Ask families about their satisfaction with each routine

▫Helps them solidify how much they really want to change it

▫Provides some insight into the family’s quality of life

On a scale of 1 to 5, how well is this time of day working for you?

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6 Steps for Completing an Interview

• Step #4: Worry & change questions▫When you lie awake at night, worrying, what is

it you worry about?▫ If there’s anything you could change in your

life, what would it be?• Step #5: Identify concerns and priorities

▫Parent selects outcomes and prioritizes

• Step #6: Write outcomes ▫ Informal outcome statements into formal ones

using 7-step process

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Quality Indicators of an Interview•Active listening

▫Repeats what the parent says vs. simply saying, “Okay”

• In-depth follow-up questions▫Helps the parent paint a picture of the

routine and child’s functioning within routine

•Continuing conversation▫Not ask, listen, write, ask, listen, write

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Quality Indicators of an Interview• Proactive questioning about child development

▫What the child is likely to do next

• “Smart questions” ▫Reveal understanding about family functioning

• Nonverbal messages▫Convey acceptance and interest (e.g., smiling and

nodding)

• Social milieu of routines▫Context of the child’s engagement

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Quality Indicators of an Interview•Seeking evaluative and interpretive opinions

▫Ascertaining the family’s opinion about the child’s and family’s functioning

•Managing the conversation▫Control pace, deal with distractions, etc.

•Empathizing▫Convey understanding and emotional

connection with both hardships and successes

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Practice, Get a Feel for the RBI • Divide into groups of 2 to 3 people

• Decide who will be the parent, who will be the interviewer(s), and the note taker

• Mothers read vignette

• Interviewers use the RBI protocol and note taking form to go through the interview

• Debrief

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The IFSP Process happens in the “Context of the Family’s Everyday Life”

▫ Identify priorities & concerns and resources within the context of the family’s daily life

▫ Assess the child’s functioning (and development) in the context of the family’s daily life

▫ Identify opportunities to help the family help their child make progress toward IFSP outcomes in context of the family’s daily life

▫ Develop IFSP outcomes that can be addressed in the context of the family’s daily life

▫ Plan strategies and activities that address outcomes with families and other caregivers in the context of the family’s daily life

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Types of Information

• Family concerns & priorities (IFSP Child Outcomes)▫ What is challenging right now? ▫ What should the team address first?

• Family resources & strengths (IFSP Child Outcomes)▫ What the family has to meet their child’s needs

• Child/Family routines & activities (IFSP Child Outcomes & SFP)▫ Events and activities that occur with some regularity in the family’s

everyday life

• Child’s level of functional performance in the context of the family’s everyday life (IFSP Child Outcomes & SFP)▫ How the child uses developmental skills to function in the context of the

family’s every day routines and activities

• Child’s present levels of development and skills (IFSP Child Outcomes & SFP)▫ What the team knows about the child’s various abilities, strengths and

needs

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Questions to Consider • How do you gather information needed for

the IFSP Process?

▫Family/Child Routines & Activities

▫Concerns & Priorities

▫Resources & Strengths

▫Child’s development and functioning in the 3 global child outcome areas

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The Process Begins…

Susie, the Amazing FRC visits Jack’s house for the first time and…

explains the ESIT program to the family

shares brochures (A Family’s Guide to Early Intervention in Washington State, Family Outcomes brochure and ESIT Guiding Concepts, and DMS Family Brochure)

explains and provides parent rights and procedural safeguards, discusses reasons for referral

determines if the family wishes to participate in the Part C program

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The Process Continues…determines if the screening is needed to decide if an

evaluation/assessment is appropriate

If screening is necessary: provides Notice and Consent for screening to parents explains parent rights conducts screening

If it is determined that an evaluation is needed provides Notice and Consent for Initial Evaluation, obtains written parental consent to obtain information

from other agencies and release ESIT information, explains how the information will be shared with other team members

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45, 44, 43, 42…

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A Complex Process

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*This information is used by the team to choose a COS rating in the DMS.

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Gathering Information from Families is an Adaptive Process!

▫Team members need to know their role and responsibilities as a member of the team

▫Team members must have shared understanding of what is being assessed (i.e. define “routines & activities”)

▫Team members must have consensus on the process for each member to gather information about the family’s routines, priorities, concerns, resources, and child’s development and functioning in his everyday life

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FORMAL vs. INFORMAL

•Formal supports = 1 hour of a family’s daily life

•Intermediate supports = planned or organized

•Informal supports = a constant

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Using Information about Resources in the IFSP Process• Establish a family-centered process/relationship (not

child-centered)▫ Family’s early experiences in early intervention are

often related to the child, such as evaluation and development of the IFSP outcomes

• Build the foundation for the IFSP process with existing supports (not services)

• Develop an effective overall plan based on strengths that the family has for supporting their child’s development.

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Child/Family Information & Medical Info.

• “How is Hope’s health?”▫ “Please tell me everything about Hope’s…birth history,

medical conditions or diagnoses, illnesses, hospitalizations, vision and hearing screening and other developmental evaluations (right now)?”

• “Has Hope had previous developmental evaluations/assessments, early intervention and/or therapy services?” ▫“Can I have all of the records (right now)?”

• “So…who lives in your home?”

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One Method… The Ecomap

A graphic representation of the family supports (people and agencies) and the links to those supports

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Waking up 1. Could you describe what wake up time is like? 2. Who usually wakes up first? 3. Where does your child sleep? 4. How does your child let you know she is awake? 5. Does she want to be picked up right away? If so, is she happy when picked up? 6. Or is she content by herself for a few minutes? What does she do? 7. What is the rest of the family doing at this time? 8. Is this a good time of day? If not, what would you like to be different?

How Satisfied (1-5)? _____

Scale for Assessment of Family Enjoyment within Routines (SAFER)

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Discussion

•How do you get information from families about their concerns, priorities, resources and routines?

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Child Assessment

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Measure of Engagement, Independence, and Social Relationships (MEISR)

a Functional domain: E = engagement, I = independence, S = social relationshipsb Developmental domain: A = adaptive, CG = cognitive, CM = communication, M = motor, S = socialc Outcomes: S = positive social relations, K = acquiring and using knowledge and skills, A = taking action to meet needs

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Discussion

•How do you get information from families about their child’s development, participation, and functioning in the 3 global child outcome areas?

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IFSP Outcomes

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In a RBI model IFSP outcomes are:•Derived from functional routines-based

needs•Measurable•Logical criteria•Frequency displayed in 1 week•Behaviors MUST be necessary, meaning

without it the child would not be able to function in everyday routines

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Criteria for Functional Outcomes

•Reflect the priorities of the family•Useful and meaningful•Reflect real-life situations•Free of jargon•Measurable

•Keep IFSP outcome functional ▫Engagement, independence, and social

relationships!

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Tips for Writing Functional Outcomes

•Write outcomes that can be addressed by multiple people, at multiple times of the day, during normal routines and activities

▫“Auguste will participate in outside play by stepping up and down on to and off different surfaces”

▫NOT “Auguste will step up and down on the stair equipment in the PT Center”

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Tips for Writing Functional Outcomes

•Ask yourself, “Why is the child working on this goal?” ▫Auguste is working on this goal so he can

participate in outside play.

•Be clear! ▫NOT “Auguste will maintain a four-point

position for 30 seconds five times a day”

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Why Write Participation-Based Outcomes?•Ensures that the context in which the skill

is needed comes first, so everyone working on the outcome understands that the desired behavior (i.e., the target skill) is not meaningful in and of itself but how it helps the child participant in homes, school, and community (Wilson, Mott, & Batman, 2004).

•Prompts adults to work on the skill at the times of the day when the skill is needed.

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Participation-Based OutcomesStep 1

1. Assess functionality.

▫Begin with functional assessment!

▫What does the child need to be engaged, independent, and social in everyday activities?

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Participation-Based OutcomesStep 2

2. Identify the informal statements that represent the family’s choice of what to work on. (child-level outcomes in italics)

▫More time as a family▫Boys in own bedrooms▫More help for Helen (mother)▫Lance eating independently▫Lance saying words (meals, playtime,

hanging out)▫Lance drinking from a cup

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Participation-Based OutcomesSteps 3 & 4

• Decide which routines are involved

4. Write “[The child] will participate in [those routines].

▫Lance will participate in breakfast, lunch, and dinner.

▫Lance will participate in meals, playtime, and hanging out time.

▫Lance will participate in breakfast, lunch, and dinner.

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Participation-Based OutcomesStep 5

5. Write “…by ________ ing” inserting the desired behavior.

▫…by feeding himself independently. ▫…by saying words.▫…by drinking from a cup independently.

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Participation-Based OutcomesStep 6

• Write “We will know he can do this when he or she______” and add a measurable criterion.

▫The criterion helps to determine the purpose of the goal. Goals have 4 main purposes: To acquire a skill To generalize a skill To maintain a skill To execute fluently.

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Participation-Based OutcomesStep 6 (cont.)

▫We will know he can do this when use uses his hands, with or without a spoon, to put 10 bites into his mouth.

▫We will know he can do this when he says three different words

▫We will know he can do this when he drinks a whole cupful, holding the sippy cup independently.

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Participation-Based OutcomesStep 7

• Add a generalization criterion ▫Ask yourself, “If she did it only one time, would

that be okay?” ▫ If not, ask yourself, “How often, in how many

routines, with how many people, or in how many places would she have to do this to convince me that the shad the skill?”

▫…at breakfast, lunch, and dinner…▫…during each of the four times of day…▫…at breakfast, lunch, and dinner…

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Participation-Based OutcomesStep 8

8. Add the criterion specifying the amount of time over which the behavior needs to be displayed.

▫…in 1 week▫…in 2 weeks▫…in 1 week

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Final IFSP Child Outcome• Lance will participate in breakfast, lunch, and dinner by

feeding himself independently. We will know he can do this when he uses his hands with or without a spoon, to put 10 bites into his mouth at breakfast, lunch, and dinner in 1 week.

• Lance will participate in meals, playtime, and hanging out by saying words. We will know he can do this when he says three different words during each of the four times of day in 2 weeks.

• Lance will participate in breakfast, lunch, and dinner by drinking from a cup independently. We will know he can do this when he drinks a whole cupful, holding the sippy cup independently at breakfast, lunch, and dinner in 1 week.

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Goal Functionality Scale III

•Designed to rate seven dimensions on each IFSP Child Outcome: ▫Participation▫Specificity▫Necessity▫Acquisition criterion▫Generalization criterion▫Meaningfulness▫Time frame criterion

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Functional IFSP Child Outcome? • What would your family like to see happen for your

child/family?▫Alex will eat a meal while sitting at the table at a

restaurant.

• How will we know we’ve made progress or if revisions are needed to outcomes or services?▫Alex doesn’t go under the table at the restaurant as soon

as the family sits back down from getting food.▫Alex starts eating within 5 minutes of when the family

returns to the table from the buffet.▫Alex eats his meal when there are mild distractions

nearby such as sounds or bright lights.

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Fitting the RBI into your work with children and families• What are your initial thoughts about

implementing the RBI?• How would the RBI fit with other methods you

currently use to gather information from families?

• At what point in the IFSP process would you consider doing the RBI?

• How would the RBI fit in your EI program procedures (e.g., intake and referral)?

• # 1 Challenge to implementing the RBI▫Possible solutions…

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Thank you!